Neurosurgery demands long hours and personal sacrifice

NEW ORLEANS, Louisiana (CNN) -- "Half the people don't believe it. The others have prejudices or make assumptions about you. I seldom say, 'I'm a brain surgeon or neurosurgeon.' "

In his office above an oak-lined avenue in New Orleans, Richard Corales confesses that ego drew him to his occupation. But he tells few people what he does.

"If you're trying to buy a car, you don't get a good deal."

Some might think his career is about ritzy glamour, but he says it's really a rewarding grind. The operative word is "rewarding," he says, but the grind is indisputable.

There's surgery before sunrise, then research to review, patients to assess, bad news to break, staff to manage and, while catching a breath, an emergency dash to treat a gunshot wound to a patient's head before completing dictation and making post-operative hospital rounds after sunset.

In an ever-changing, increasingly bureaucratic field that yields about 35 cents for every dollar billed, a lot has changed since Corales started practicing almost 20 years ago. The rules of managed care, floods of research, constant medical advances and the need for office-operating savvy renders most physicians a hybrid -- part student, part doctor, part businessperson.

The days in which a physician could devote the bulk of his or her time to healing are over. But while Corales might not readily disclose his profession, he can't hide the passion he feels about his career. His hands won't let him. They're as essential to his words as they are to his work.

When the topic is the weighty matter of having patients who seem beyond help, Corales' cupped palms turn up toward the ceiling. His fingertips flatten against each other as he tents his hands to explain juggling the constant torrent of new brain-related research.

And then there's his inspiration.

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"My father was a doctor, and for as long as I have known, I wanted to be a physician," says Corales, 50. He clasps his hands to finish the thought. "At my kindergarten graduation, you dressed up as what you wanted to be. I dressed as a doctor. I wanted to emulate my father."

Corales' desire to be like his father amazes Donna Lowry, his sister and office manager. "He knew how hard it was. He saw it all. He knew about the long hours, the calls, rushing to emergencies, not having enough time at home," she says. "He didn't go into this blindly. He knew all the pitfalls, but he did it anyway."

Corales enrolled in medical school with plans to become a pediatrician. But he says he soon sought more challenging work.

"I didn't want to do the runny noses and hot ears. What I really liked was neonatology -- the little preemies and the intensity of their care," Corales says. "I loved intensive care, really sick people."

So he changed his focus, went into neuropathology and neuroscience and sought more neurosurgical rotations. In his 20s, he packed up his young wife and hauled her to Duke University, where he paid to do a neurosurgery externship that kept him on call every night.

Neurology gave Corales the demanding work he sought. And a new proximity to death. Isn't it more likely that the "really sick people" will die?

Corales has a two-part answer, and a postscript.

-- Part one: "I may not be able to make them better, but I can keep them from getting worse."

-- Part two: "If you always take care of well people, you rarely ever fail. If you confront failure, it makes you grow."

-- And the p.s. comes with some vainglory: "To take care of high-risk patients, you have to have a bit of an ego," Corales says. "Your ego gets you into the specialty -- and then the specialty humbles you."

Seldom does a a month go by without researchers announcing new information about the brain.

There are findings on stroke, Alzheimer's disease, memory, intellectual development and myriad other topics.

"The 1990s were the decade of the brain," Corales says. "There was research on MS (multiple sclerosis), ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease), Parkinson's and the spinal cord -- just tremendous funding in this specialty and maybe at the expense of others."

Keeping up with new information is essential to providing patients with the best care, but it absorbs so much of a brain surgeon's time, Corales says. "It's difficult to have an active practice -- a private practice -- and not be a part of a large, academic institution and stay on top of the game."

Some doctors at teaching hospitals have time allotted to read and perform research. But the demands on a physician in private practice are constant and diverse -- a staff to oversee, an office to run, patients to treat, research to study, post-operative rounds to make.

Corales, who's also the chairman of the neurosurgical department at East Jefferson General Hospital in Metairie, Louisiana, says he has a method for juggling it all: He schedules time for reviewing new research, attending seminars and continuing his medical education. Those are workdays without patients.

And he utilizes the skills of his colleagues. Most neurosurgeons have specialties. They're a close-knit group, says Corales, who primarily handles pituitary surgery, aneurysms and tumors. If a patient has a problem Corales sees rarely, he'll make a referral to another physician who knows that condition.

"You don't get on a tiger's back unless you can ride that tiger," Corales says. "With faxes, digital images and e-mail, it doesn't take long to find someone with the specialty a patient needs."

Making referrals diminishes some of the grueling workload of a brain surgeon, but it doesn't create more free time. On many days, by the time the staff arrives at either of the two offices Corales and his three partners maintain, he already has performed two surgeries and started rounds at the hospital.

"A person who was very dear to me said something to me many, many years ago: 'If you're going to be a true professional, not just do the job, and if you want to be a husband or a father, you can't do anything else.'" Corales has two adult sons and a teen-age daughter. "You can't do the social scene or go on golf jaunts. You make that sacrifice."

A photo of Corales donning a shamefully lively shirt with a tropical print stands on his office bookcase amid his texts -- "Trauma to Nerves in Limbs" and "The Pituitary Gland." The picture testifies to the choices he makes. The caption reads "Father Daughter Luau."

None of his children plan to pursue his career or the sacrifices it requires, but he knows other young people will. And for them, he has advice.

"In this time of decreasing rewards and increasing overhead, you need to make sure you go into the field for the right reason. The biggest reward isn't going to be monetary. It's that feeling that you did good today. It's not even something that you tell other people about," says Corales.

"You ride home at the end of the day, and you pat yourself on the back and know that you helped people."